Witholding CPR or other resuscitation.

[mycrofft]

OK, you respond to a 63 y/o lady's house where she is on the floor, not room temp but unresponsive and not breathing. Resuscitation sequence is just begun, but upon not finding a pulse by palpation or auscultation and the eyes found to be dilated and unresponsive, the crew chief calls it off.

Upon returning to the station or office, you review the company protocol and it says to "work the code" no matter what.

The crew chief says "She was dead, it never works, we saved her and her friends a lot of misery and indignity".

Now, using YOUR local protocols, EMSA rules, etc., comment and discuss:

Was this an unjustified death? Will the coroner and medical examiner look this one over and entertain findings of willful negligence, homicide, malpractice?

PS: YOU CAN SELECT MULTIPLE ANSWERS, DON'T ABUSE IT.

 

[JMorin95]

If there were no signs that she had been dead or no injuries incompatible with life then our local protocol says to work the code for 20 minutes. After 20 minutes we can choose to either stop resuscitation efforts or continue.

 

[mycrofft]

SO your vote is........:huh:

 

[JMorin95]

My vote is: your supervisor could be in a heap of trouble. Protocols were not followed.

 

[Shishkabob]

Wrongful death/homicide? No, because you didn't cause the death.

Negligence? Yup. Re-education is in order.



Sure, most don't come back, but if they meet the criteria, work it and leave them there knowing all that could have been done, was.

 

[mycrofft]

I'm talking criminal trouble here, felonies, potentially prison time, throw open the road to civil damages crime-time.

 

[Shishkabob]

No to criminal, no to civil.



Criminal: You didn't cause it, therefor it isn't a crime.

Civil: You have to prove causation. You have to prove that if something else was done, it would have had a different outcome. You can't prove that in a cardiac arrest.

 

[mycrofft]

(I have this evil impulse about the polls. Invite replies, then reply your self "WRONG!!!!".:rofl:

I don't post polls you can see who voted what on).

 

[Rialaigh]

Without at least a 3 lead confirmation you work it all day. If its a nice flatline in 2 out of 3 leads we can call it. Based on your scenario most of the criteria to work or not would be based on the whether the caller witnessed the arrest.

Either way, if no 3 lead confirmation you have to work it into the hospital. With this scenario it would be negligence. With the right lawyer he could probably make enough of a fuss to warrant some civil settlement if this patient was otherwise completely healthy and blah blah blah..

 

[NomadicMedic]

Amen. I'm not calling anything until I see electrical activity, or the lack of it, on my monitor. Anything else would be negligent.

 

[cprted]

Not enough info here.

How long were they down? Cause of the arrest? Pt hx? Initial rhythm? Bystander CPR? Signs of obvious death (livitidy, temp, etc)?

The crew chief says "She was dead, it never works, we saved her and her friends a lot of misery and indignity".

There are so many things wrong with this statement, I don't even know where to begin ...

 

[ChorusD]

Not enough info here.

How long were they down? Cause of the arrest? Pt hx? Initial rhythm? Bystander CPR? Signs of obvious death (livitidy, temp, etc)?

There are so many things wrong with this statement, I don't even know where to begin ...

I agree with this.

Rigor and livor mortis can pretty well be absolute indicators of the futility of CPR in a particular patient.

In my opinion, if your physical assessment reveals rigor mortis and postmortem lividity, there is no need for an EKG. Again, that is my opinion and my protocols allow for such.

As for the example, maybe he saw something the others didn't. However, around here if you start CPR you usually need to call for orders to discontinue.

 

[mycrofft]

...................

Not enough info here.

How long were they down? Cause of the arrest? Pt hx? Initial rhythm? Bystander CPR? Signs of obvious death (livitidy, temp, etc)?


"on the floor, not room temp but unresponsive and not breathing. Resuscitation sequence is just begun, but upon not finding a pulse by palpation or auscultation and the eyes found to be dilated and unresponsive". That's all you have. She still has not cooled to room temp, no lividity is mentioned for the same reason her missing tattoos and nonexistent extra toes were not mentioned. Pt went down unwitnessed.

There are so many things wrong with this statement, I don't even know where to begin ...

One our co-forum members made such a statement at an earlier time, generically calling CPR useless.

 

[rescue1]

OK, you respond to a 63 y/o lady's house where she is on the floor, not room temp but unresponsive and not breathing. Resuscitation sequence is just begun, but upon not finding a pulse by palpation or auscultation and the eyes found to be dilated and unresponsive, the crew chief calls it off.

Upon returning to the station or office, you review the company protocol and it says to "work the code" no matter what.

The crew chief says "She was dead, it never works, we saved her and her friends a lot of misery and indignity".

Now, using YOUR local protocols, EMSA rules, etc., comment and discuss:

Was this an unjustified death? Will the coroner and medical examiner look this one over and entertain findings of willful negligence, homicide, malpractice?

I can't imagine why a BLS tech would call a code without obvious signs of death, but if he did where I came from, heads would likely roll and job openings would likely appear.

I don't think there would be any court actions though...it's certainly not homicide to not start CPR on someone. I don't know about negligence lawsuits though. However, I wouldn't be surprised to see certifications be pulled for protocol violation.

 

[mycrofft]

A hint. Most states consider willful negligence (superficially summed up as "not following the protocols despite knowing them") grounds for action; it certainly negates off-duty or layperson Good Sam coverage.